气道阻力和静态肺顺应性测定在重型颅脑损伤患者脱机筛查中的应用研究

祁彬; 姜宇辉; 张贺; 杜文杰

doi:10.16766/j.cnki.issn.1674-4152.003632

气道阻力和静态肺顺应性测定在重型颅脑损伤患者脱机筛查中的应用研究

doi: 10.16766/j.cnki.issn.1674-4152.003632

亳州市人民医院重症医学科，安徽亳州 236800

基金项目:

安徽省卫生健康科研项目 AHWJ2022c033

详细信息

通讯作者:
杜文杰, E-mail: duwenjie-666@163.com

中图分类号: R651.1;R459.7
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- 文章访问数: 3
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出版历程
- 收稿日期: 2023-12-18
- 网络出版日期: 2024-11-19

Airway resistance and static lung compliance determination application offline screening for patients with severe craniocerebral injury

Department of Critical Care Medicine, Bozhou People ' s Hospital, Bozhou, Anhui 236800, China

摘要

摘要: 目的机械通气延迟脱机和困难脱机是重型颅脑损伤患者治疗中的难点，本文旨在通过分析气道阻力和静态肺顺应测定在呼吸机脱机筛查中的应用价值，缩短此类患者的机械通气时间。方法选取亳州市人民医院重症医学科一病区2023年1—11月收治的重型颅脑损伤患者78例，使用随机数字表法将患者分为实验组(39例)和对照组(39例)，所有患者均予以脱水降颅压、维持脑灌注、雾化祛痰、镇静镇痛、营养支持等治疗。对照组依据传统脱机筛查方法实行呼吸机脱机，实验组在气道阻力(Raw)≤10 cmH₂O·L^-1·s^-1，静态肺顺应性≥40 mL/cmH₂O基础上应用传统呼吸机脱机筛查方法实行呼吸机脱机，比较2组ICU住院时间、呼吸机使用时间、自主呼吸试验(SBT)次数、48 h呼吸机再次上机率、呼吸机相关性肺炎(VAP)发生率、住院总时间、医疗总花费。结果实验组ICU住院时间为11(6，16)d，短于对照组[13(15，19)d，P＜0.05]；实验组呼吸机通气时间为141(46，230)h，短于对照组[212(151，254)h, P＜0.05]；实验组SBT次数少于对照组[1(1，1)次vs. 2(1，3)次，P＜0.05]；实验组住院总时间短于对照组[29(20，44)d vs. 41(32，62)d，P＜0.05]；实验组医疗总花费、VAP发生率和48 h再上机率均小于对照组(P＜0.05)。结论气道阻力和肺顺应性测定联合传统呼吸机脱机筛查方法更有利于重型颅脑损伤患者呼吸机脱机，缩短呼吸机使用时间和ICU住院时间，降低医疗花费及VAP的发生率。
- 重型颅脑损伤 /
- 呼吸机脱机 /
- 气道阻力 /
- 静态肺顺应性
Abstract: Objective Delayed weaning and difficult weaning of mechanical ventilation are the difficulties in the treatment of patients with severe craniocerebral injury. This paper aims to shorten the mechanical ventilation time of such patients by analyzing the application value of airway resistance and static lung compliance in ventilator offline screening. Methods Seventy-eight patients with severe craniocerebral injury admitted to the First Ward of ICU at Bozhou People ' s Hospital from January 2023 to November 2023 were selected and randomly divided into an experimental group (n=39) and a control group (n=39). All patients received dehydration therapy to reduce intracranial pressure, maintain cerebral perfusion, nutritional support, aerosol expectoration, sedation and analgesia, as well as other treatments. The control group underwent traditional ventilator weaning screening method while the experimental group underwent traditional ventilator weaning screening method based on airway resistance (Raw) ≤10 cmH₂O·L^-1·s^-1 and static lung compliance ≥40 mL/cmH₂O. The ICU length of stay, ventilator duration, number of spontaneous breathing trial, 48 h ventilator re-up rate, incidence of ventilator-associated pneumonia (VAP), total length of hospitalization, and total healthcare expenditure were compared between the two groups. Results The length of ICU stay was 11 (6, 16) days in the experimental group, which was shorter than that in the control group [13 (15, 19) days, P < 0.05]. The duration of mechanical ventilation was 141 (46, 230) hours in the experimental group, which was shorter than that in the control group [212 (151, 254) hours, P < 0.05]. The number of spontaneous breathing trials (SBT) in the experimental group was less than that in the control group [1 (1, 1) vs. 2 (1, 3), P < 0.05]. The total length of hospital stays of the experimental group was shorter than that of the control group [29 (20, 44) d vs. 41 (32, 62) d, P < 0.05]. Additionally, there were lower total medical costs as well as reduced incidence rates of VAP, and re-hospitalization within 48 hours observed among patients from the experimental group compared to those from the control group (P < 0.05). Conclusion Airway resistance and lung compliance measurement combined with traditional ventilator weaning screening method is more conducive to ventilator weaning in patients with severe craniocerebral injury, shortening the duration of ventilator use and ICU stay, and reducing the total length of hospital stay and medical costs, and reduce the incidence of VAP.
- Severe craniocerebral injury /
- Ventilator weaning /
- Airway resistance /
- Static lung compliance

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表 1 2组重型颅脑损伤患者基线资料比较

Table 1. Comparison of baseline data between the two groups of patients with severe craniocerebral injury

组别	例数	年龄(x±s，岁)	性别[例(%)]		基础疾病 [例(%)]	APACHE Ⅱ评分 [M(P₂₅, P₇₅), 分]	GCS评分 [M(P₂₅, P₇₅), 分]
组别	例数	年龄(x±s，岁)	男性	女性	基础疾病 [例(%)]	APACHE Ⅱ评分 [M(P₂₅, P₇₅), 分]	GCS评分 [M(P₂₅, P₇₅), 分]
实验组	39	58.87±16.26	29(74.4)	10(25.6)	32(82.1)	16(15，20)	5(5，5)
对照组	39	54.28±11.64	27(69.2)	12(30.8)	31(79.5)	18(15，22)	5(3，5)
统计量		1.433^a	0.253^b		0.083^b	-0.980^c	-1.761^c
P值		0.156	0.615		0.774	0.327	0.078
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组重型颅脑损伤患者实验数据比较

Table 2. Comparison of experimental data between the two groups of patients with severe craniocerebral injury

组别	例数	呼吸机使用时间 [M(P₂₅, P₇₅), h]	ICU住院时间 [M(P₂₅, P₇₅), d]	总住院时间 [M(P₂₅, P₇₅), d]	总费用 [M(P₂₅, P₇₅), 元]	SBT [M(P₂₅, P₇₅), 次]	VAP [例(%)]	48 h呼吸机再上机 [例(%)]
实验组	39	141(46，230)	11(6，16)	29(20，44)	99 013.04(75 679.95，165 425.35)	1(1，1)	6(15.4)	8(20.5)
对照组	39	212(151，254)	13(15，19)	41(32，62)	138 379.57(98 690.68，206 513.83)	2(1，3)	14(35.9)	23(59.0)
统计量		-2.369^a	-2.503^a	-2.494^a	-2.149^a	-4.012^a	4.303^b	11.891^b
P值		0.018	0.012	0.013	0.032	＜0.001	0.038	＜0.001
注：^a为Z值，^b为χ²值。

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参考文献(15)

[1]	高敏, 韩小彤, 张兴文, 等. 探讨中重型颅脑损伤机械通气患者拔管的预测因素[J]. 中国呼吸与危重监护杂志, 2023, 22(4): 274-280. GAO M, HAN X T, ZHANG X W, et al. Exploring predictive factors for extubation in mechanically ventilated patients with moderate to severe traumatic brain injury[J]. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(4): 274-280.
[2]	马亮, 裴荣权, 李立新, 等. 早期高压氧联合去骨瓣减压治疗重型颅脑损伤的疗效及对患者神经功能、炎性因子的影响[J]. 现代生物医学进展, 2023, 23(10): 1889-1893. MA L, PEI R Q, LI L X, et al. Effect of early hyperbaric oxygen combined with decompressive craniectomy on severe craniocerebral injury and its effect on neurological function and inflammatory factors[J]. Progress in Modern Biomedicine, 2023, 23(10): 1889-1893.
[3]	陈丽金. 以循证为指导的人工气道集束化护理对颅脑损伤患者呼吸机相关性肺炎预防作用[J]. 中国医药指南, 2023, 21(32): 144-146. CHEN L J. Prevention of ventilator-associated pneumonia in patients with craniocerebral injury under the guidance of evidence-based artificial airway cluster nursing[J]. Guide of China Medicine, 2023, 21(32): 144-146.
[4]	李小玉, 李向阳, 臧鑫亚, 等. ICU重型颅脑损伤患者感染控制现况调查及影响因素分析[J]. 实用预防医学, 2023, 30(12): 1520-1523. doi: 10.3969/j.issn.1006-3110.2023.12.027 LI X Y, LI X Y, ZANG X Y, et al. Current status and influencing factors of infection control in ICU patients with severe craniocerebral injury[J]. Practical Preventive Medicine, 2023, 30(12): 1520-1523. doi: 10.3969/j.issn.1006-3110.2023.12.027
[5]	HAWRYLUK G W J, RUBIANO A M, TOTTEN A M, et al. Guidelines for the management of severe traumatic brain injury: 2020 update of the decompressive craniectomy recommendations[J]. Neurosurgery, 2020, 87(3): 427-434. doi: 10.1093/neuros/nyaa278
[6]	ROBBA C, POOLE D, MCNETT M, et al. Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus[J]. Intensive Care Med, 2020, 46(12): 2397-2410. doi: 10.1007/s00134-020-06283-0
[7]	VETRUGNO L, GUADAGNIN G M, BRUSSA A, et al. Mechanical ventilation weaning issues can be counted on the fingers of just one hand: part 1 [J]. Ultrasound J, 2020, 12(1): 9. DOI: 10.1186/s13089-020-00161-y.
[8]	ROBINSON C P. Moderate and severe traumatic brain injury[J]. Continuum(Minneap Minn), 2021, 27(5): 1278-1300.
[9]	GAMBERINI L, GIUGNI A, RANIERI S, et al. Early-onset vent-ilator-associated pneumonia in severe traumatic brain injury: is there a relationship with prehospital airway management?[J]. J Emerg Med, 2019, 56(6): 657-665. doi: 10.1016/j.jemermed.2019.02.005
[10]	LI Y T, LIU C X, XIAO W, et al. Incidence, risk factors, and outcomes of ventilator-associated pneumonia in traumatic brain injury: a meta-analysis[J]. Neurocrit Care, 2020, 32(1): 272-285. doi: 10.1007/s12028-019-00773-w
[11]	周婷, 金琳, 谢莉. 基于倾向性评分匹配分析急诊重型颅脑损伤并发呼吸机相关性肺炎的影响因素[J]. 河南医学高等专科学校学报, 2023, 35(3): 247-252. ZHOU T, JIN L, XIE L. Analysis of factors influencing emergency heavy craniocerebral injury complicated with ventilator-associated pneumonia based on propensity score matching[J]. Journal of Henan Medical College, 2023, 35(3): 247-252.
[12]	钟海莲, 王迎斌. 呼吸力学监测指导COPD患者机械通气的研究进展[J]. 解放军医学杂志, 2022, 47(12): 1262-1267. ZHONG H L, WANG Y B. Research progress of respiratory mechanics monitoring in guiding mechanical ventilation of patients with COPD[J]. Medical Journal of Chinese People ' s Liberation Army, 2022, 47(12): 1262-1267.
[13]	TAKAHASHI K, TOYAMA H, KUBO R, et al. Effectiveness of substantial shortening of the endotracheal tube for decreasing airway resistance and increasing tidal volume during pressure-controlled ventilation in pediatric patients: a prospective observational study[J]. J Clin Monit Comput, 2023, 37(6): 1513-1519.
[14]	李颖, 张铁峰, 蒋海斌, 等. 肺保护性通气用于老年腹腔镜结直肠癌手术患者的临床观察[J]. 中华全科医学, 2019, 17(10): 1673-1677. doi: 10.16766/j.cnki.issn.1674-4152.001026 LI Y, ZHANG T F, JIANG H B, et al. Clinical observation of lung protective ventilation in elderly patient undergoing laparoscopic colorectal cancer surgery[J]. Chinese Journal of General Practice, 2019, 17(10): 1673-1677. doi: 10.16766/j.cnki.issn.1674-4152.001026
[15]	徐名雄, 廖深福, 罗林丽. ICU机械通气患者发生呼吸机相关性肺炎的影响因素及其与预后的相关性[J]. 中外医学研究, 2021, 19(17): 183-185. XU M X, LIAO S F, LUO L L, et al. Influencing factors of ventilator-associated pneumonia in icu patients with mechanical ventilation and its correlation with prognosis[J]. Chinese and Foreign Medical Research, 2021, 19(17): 183-185.